What are the billing rules for C085A?

Needs a written, signed request from a physician or nurse practitioner naming you or your specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart and send a written report, or it is paid as a lesser assessment (GP16). Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second is allowed only for an in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Extras are paid as an assessment (GP17–GP18). A surgeon can't bill the hospital admission assessment unless it is the major pre-operative visit (SP2, GP40).

Why is C085A rejected?

ARF: OHIP describes this as 'Missing Physician Referring Number'. A consultation is paid only on a written referral from a physician or nurse practitioner (GP16); enter the referrer's billing number.

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Billing code

C085A — In-patient consultation – plastic surgery

Q: What is OHIP billing code C085A?

Plastic surgery consultation for a hospital in-patient, at the referral of a physician or nurse practitioner.

Plastic surgery in-patient consultation

Bill C085 for a plastic surgeon's consultation on a hospital in-patient, referred by a physician or nurse practitioner.

Watch for: Keep the signed request with the referrer's billing number in the chart and send a written report, or it pays less.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$0.00	$106.25	$0.00	$0.00	$0.00

Code: C085A
Description: In-patient consultation – plastic surgery
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Plastic surgery consultation for a hospital in-patient, at the referral of a physician or nurse practitioner.

What it covers

A consultation is requested by a physician or nurse practitioner because of the complexity, seriousness or obscurity of the case, or because another opinion is requested. It includes the assessment and a written report with findings, opinions and recommendations (GP16).

C085 is the non-emergency hospital in-patient listing for plastic surgery (A181).

Billing rules

Needs a written, signed request from a physician or nurse practitioner naming you or your specialty, the referrer and billing number, the patient and health number, and the reason; keep it in the chart and send a written report, or it is paid as a lesser assessment (GP16).
Same patient, same diagnosis: one consultation per two consecutive 12-month periods (a second is allowed only for an in-patient or ED patient 12–24 months after the first); a clearly unrelated diagnosis allows one per 12 months. Extras are paid as an assessment (GP17–GP18).
A surgeon can't bill the hospital admission assessment unless it is the major pre-operative visit (SP2, GP40).
Age premiums apply for patients under 16, from 10% to 30% by age (GP64).
By video only (not phone), and for in-patients only if you aren't the MRP, no local physician with the expertise is available (documented by the referrer), and the referrer assessed the patient in person within the prior 30 days (Appendix J, A69).
For emergency calls and other special visits to in-patients, use the general listings (A-prefix) with special visit premiums instead (A181, GP65–GP78).

Common rejections

ARF: OHIP describes this as 'Missing Physician Referring Number'. A consultation is paid only on a written referral from a physician or nurse practitioner (GP16); enter the referrer's billing number.

Related codes: C086, C935, C083, C084, A085, W085

Source: Schedule of Benefits (July 1, 2026), Consultations and Visits, Plastic Surgery (08), page A181; rules GP16–GP18.

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